HomeMy WebLinkAboutLA102082 PERMIT
City of Lakeville Permit Type: Plumbing
20195 Holyoke Ave Permit Number: LA102082
Lakeville, MN 55044 Date Issued: 08/03/2007
(952) 985-4440
www.ci.lakeville.mn.us
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Site Address: 16463 Elm Creek La
' Lot: Block: Addition:
PID:
Use:
Description:
Sub Type: Comm/Multi-Family Lawn Sprinkler
Work Type: New
Description: Doghouse for Fieldstone Creek 2nd
Meter Size Meter Tune Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: Description mount Revenue Code
PL-Commercial (Minimum) $39.50 1000-4152
Surcharge (.50) $0.50 1000-2127
Water Meter $350.00 7600-5161
Reducing Valve $250.00 7600-5165
MXU $130.00 7600-5163
Total: $770.00
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Contractor: -Applicant - Owner:
PLYMOUTH PLMBG INC
12270 43RD ST. NE
ST. MICHAEL MN 55376
(763) 533-4357
I HEREBY AGREE THAT THIS WORK WILL BE PERFORMED ACCORDING TO: (1) THE APPROVED PLANS &
SPECIFICATIONS; (2) THE APPLICABLE CITY ORDINANCES & CODES; AND (3) THE MN STATE BUILDING CODE. A
SEPARATE ELECTRICAL PERMIT IS REQUIRED
Applicant/Permitee: Signature Issued By: Signature
PLUMBING PERNIIT APPLICATION office use only
•'~y CITY OF LAKEVTLLE Permit Number .
~~.~}I-'if- BUILDING INSPECTIONS DEPARTMENT
20195 HOLYOKE AVENUE Received By -
LAKEVII,LE, MN 55044
952-985-4440 ~ ~
www.ci.lakeville.mn.us Date Received W
e
DATE S D'1 YOUR E-MAIL ADDRESS ~
SITE ADDRESS Ito ~-1 < 1?~r~ Grc.Ll~ t_~ ~ "'O
TENANT SUITE NO. ~
THE APPLICANT IS: ? RESIDENT OWNER ,'CONTRACTOR
P
NAME
RESIDENT OWNER ADDRESS
CITY STATE ZIP
DAYTIME PHONE # WHERE YOU CAN BE REACHED
COMPANY NAME p (~l ~noy~.~ 1~L ~ t~ ~ ~C, .LICENSE # 39 I Z
ADDRESS 1 Z2'l b y?~ r'd~ it1G
CONTRACTOR CITY S~' w~ ~ t.~V~C`.~ STATE Inn ~.1 ZIP S "j ~ 1 lp
OFFICE PHONE # 'l ~p 3 - ~q L -lo t b0 FAX # "l b ~ - ~IcI L ' to2bo
CONTACT NAME u PHONE'1 lv 3 ' Vq b ~ (o lS$
..COMMERCIAL ONLY RESIDENTIAL ONLY
? COMM PLMBG SYSTEM ? LAWN SPRINKLER ? INSIDE PLBG
PERMIT TYPE ? COMM/MULTI-FAMILY ? WATER SOFTENER CONVERSION
LAWN SPRINKLER ? WATER HEATER ? ADDN/REPAIR
? FIRE SPRINKLER ? MISC
? RPZ (Available on-line) ResidentiadPermitsAvailable on-line
? NEW ? ADDITION ? ALTER /REMODEL
TYPE OF WORK
- _ _ ? REPAIR ? REPLACE... ? DEMOLITION
1 J
JOB DESCRIPTION v, i r v- ~ o r ~a,~ , v~r L~,~,,,~ ~ n v~.s~, I ~ 2 J
RESIDENTIAL FEES:
i Repairs/Remodel or Water Heater $40.00 (39.50 + .50 surcharge) Water Softener $20.00 (19.50+ .50 surcharge)
COMMERCIAL FEES:
JOB COST: $ 1 ~°~S . d c7
Example: $12,000 Job Cost
1-1/2% of contract cosf up to $10,000 and $10,000.00 x 1.5% _ $150.00
1% of cost above $10,000 plus surcharge. + $ 2,000.00 x 1% = 20.00
Surchar e = _
Contract Cost x .0005 +
( g ) $12,000 x .0005 6.00
TOTAL = TOTAL $176.00
Minimum of $40.00 (39.50 + .50 surcharge)
NO.OF METERS SIZE OF METER LOCATION OF METER
1 t`12 " 'rr.
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Lakeville and with the Mimiesota Plumbing Codes- that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in
the case ofall work which requires review andnnapproval of plans.
NAME OF APPLICANT (Please Print) Kt] Date $ O'1
SIGNATURE OF APPLICANT:
PLEASE' 1V0'l'T: SEP;~RATL PERVi S,aR EQIiIREI I'OR A\l' Bli1LDING, ~i CCICAIV'1(' AL & Ei,F,CTRIC:~I_. VVOI:I: -
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PLUMBING PERMIT APPLICATION PAGE 2
OFFICE USE
SYSTEM TYPE: INSPECTIONS:
i/NEW ROUGH-IN
ADDITION FINS,
PAIR ~-''f RPZ TEST REPORT
DEMOLISH COMBUSTION AIIZ
REPLACE UNDERGROUND
ALTER/REMODEL
PERMIT FEE:
'1.~
PERMIT FEE: $ ~ ~
SURCHARGE: $ ~~.L
i
METER: $ ~ J~ i y
_ _ _ REDUCING VALVE: $ _ - _ _ _ -
MXU $ ~
.OTHER: $
TOTAL: $
ISSUEDBY: ~:~`i .DATE: ~'.,3
COMMENTS:
Revised 06/20/2007